Postpartum visit attendance dropped in first months of COVID-19 pandemic

During the first 9 months of the COVID-19 pandemic, attendance at postpartum visits fell by 5.8 percentage points, according to a research letter published in Obstetrics & Gynecology.

“Our study found that groups who already faced disproportionate barriers to care — Black and Hispanic women, young women and women without postpartum insurance coverage — experienced the greatest declines in postpartum visit attendance during the pandemic,” Meghan Bellerose, MPH, a PhD student at the Brown University School of Public Health in Providence, Rhode Island, said in a press release. “These are the same groups who experience higher rates of postpartum complications and maternal mortality, so it’s imperative that we understand the factors preventing them from receiving important pregnancy care.”

Bellerose and Maria W. Steenland, PhD, an assistant professor of population studies (research) at Brown University, analyzed survey data from the Pregnancy Risk Assessment Monitoring System (PRAMS) available from 2016 to 2020. Specifically, they evaluated rates of self-reported postpartum visit attendance, and further analyzed differences in attendance by race and ethnicity, age and postpartum insurance coverage.

Overall, the rate of attending postpartum visits decreased by 5.8 percentage points during the first 9 months of the pandemic (95% CI, –6.4 to –5.2).

Subgroup analyses

Race and ethnicity analyses revealed the largest declines occurred among non-Hispanic Black participants (–9.9 percentage points; 95% CI, –11.6 to –8.1). Compared with non-Hispanic white participants, the drop in attendance was greater among non-Hispanic Black (5.9 percentage points; 95% CI, 4-7.8) and Hispanic (3.1 percentage points; 95% CI, 1.2-5) participants.

Participants aged 19 years or younger had the greatest decrease in visit attendance (–9.9 percentage points; 95% CI, –13.5 to –6.2).

Further, uninsured participants had the greatest decrease in attendance (–11.4 percentage points; 95% CI, –14.5 to –8.3). Compared with privately insured participants, the decrease among uninsured participants was 7.6 percentage points greater (95% CI, 4.4-10.7). Participants who reported Medicaid insurance also experienced a greater decrease in attendance vs. privately insured participants (2.6 percentage points; 95% CI, 1.2-3.9).

Reasons for nonattendance

In seven states that collected information on the reason for not attending postpartum visits, common reasons included being “too busy,” not being able to leave work, lack of insurance and lack of transportation. However, the percentage of participants reporting these decreased during the pandemic, whereas the percentage of participants responding in an open-ended format increased, with the most common responses being lack of child care and fear of leaving home due to the pandemic.

“To reduce ongoing disparities in postpartum care, clinical practices must ensure that care is provided in a way that accommodates the preferences and needs of all patients — including postpartum people who don’t have broadband access at home or who face ongoing barriers due to transportation, child care and work schedules,” Steenland said in the release.

References:

• Bellerose M, et al. Obstet Gynecol. 2022;doi:10.1097/AOG.0000000000005014.
• Postpartum visits declined during COVID-19, especially among Black, young and uninsured women. www.brown.edu/news/2022-12-02/covid-postpartum. Published Dec. 2, 2022. Accessed Dec. 7, 2022.